Robotic device aids research for children with brain injuries

Dressed in a stylish T-shirt and sweat pants with his light blonde hair parted to the side, twelve-year-old Max Challoner looks much like any other boy his age. But, unlike most children, he suffered from a perinatal stroke towards the end of his time in his mother’s womb or shortly after being born.

He would suffer from seizures every few minutes when he was just a day old and had to spend days in an intensive care unit before he could go home. Today, he has regained most of his physical mobility and talks like any other kid, but he finds it tiring to write with his right hand. His strokes become sloppy after just two sentences, he says, so he gets by in class by taking pictures of the board, as well as by using a computer and an iPad.

Difficulties moving one side of the body are common among the 1,000 children in Alberta that living with the consequences of a perinatal stroke. In many cases, they deal with far worse than Max and some end up with cerebral palsy that affects their muscle movement and motor skills.

Now, a group of Calgary researchers hopes to transform therapies to help these children with data from a robot that measures their proprioception, or position sense. That’s basically your unconscious perception of where parts of your body are and enables you to do things like touching your nose while your eyes are closed.

“The sensory side of things, which is where we’re finally able to explore with the robot, is really a wide open area of function that we haven’t been able to measure before,” said Adam Kirton, a physician and specialist in perinatal stroke who is the senior researcher on the study.

“Now that we can measure it and we can see what’s wrong with it, we’re going to be able to start testing new therapies focused on sensation, rather than just on movement.”

Historically, treatments for children like Max have focused on visible challenges they face with movement. If they have a weak arm, treatments focus on making it stronger and faster, but this has a limited impact if a child doesn’t know where his or her arm is in space, Kirton said.

The University of Calgary study, with research carried out by PhD candidate Andrea Kuczynski, uses an exoskeletal robot called the KINARM – short for Kinesiological Instrument for Normal and Altered Reaching Movements – to better understand children’s sense of where their arms and hands are in space and how they’re moving through space, as well as how quick, accurate and strong they are.

Children sit in a chair built into the robot where they play video games and complete various tasks as Kuczynski uses a computer hooked up the robot to see how their brains process their movements. Afterwards, the children participate in a session with an MRI machine so Kuczynski can see how regions of their brain function in relation to their ability to move.

So far, 47 children with perinatal stroke and 124 healthy control children from ages six through to 19 have participated in the study. To the researchers’ knowledge, it is the only study of its kind in the world.

Comparing data from children without brain damage to those who have suffered a perinatal stroke, as well as different children who have suffered from perinatal stroke, may transform therapies for such youth.

Two children can suffer similar brain damage because of a stroke at birth and have similar MRI scans once they are older, but end up with very different disabilities, said Kirton. While Max is mobile, another child with similar brain damage might barely be able to move at all, he added.

Understanding these differences, researchers can develop therapies to help “train the brain to learn better” such as by stimulating the brain in ways that might enhance its ability to learn a new skill, said Kirton.

The researchers will conclude the first stage of the study, which started in 2013, this year. They will use the data they’ve gathered with the KINARM robot to plan clinical trials that will be rolled out over the next one to two years to test possible treatments for children who have suffered from perinatal strokes.

The end result, they hope, will be “personalized, precision medicine” for children with physical disabilities related to brain damage, Kirton said.

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